Pulmonary Disorders Notes

Describe the pathophysiology of oxygenation disorders using examples.
Describe major risk factors for developing oxygenation disorders using examples.
Use the nursing process as a framework for patient care with oxygenation disorders.
Apply best practice guidelines on disease prevention and collaborative disease management, including pharmacologic and nonpharmacologic therapies.

An obstructive disease.
Often included in the COPD (Chronic Obstructive Pulmonary Disease) classification as Chronic Asthma.
A disease involving periodic episodes of severe but reversible bronchial obstruction.
Onset commonly occurs in children, with attacks sometimes ceasing after adolescence.
Triggers include respiratory infections, exposure to cold, exercise, drugs like aspirin, stress, and inhalation of irritants such as cigarette smoke.

The bronchi and bronchioles respond to stimuli with three changes:
- Inflammation of the mucosa with edema.
- Contraction of smooth muscle (bronchoconstriction).
- Increased secretion of thick mucus in the passages.
Partial obstruction of the small bronchi and bronchioles results in air trapping and hyperinflation of the lungs.
Residual volume increases, making it more difficult to inspire fresh air or cough effectively to remove mucus.
Both partial and total airway obstruction lead to marked hypoxia.

History
- A family history of hay fever, asthma, and eczema is common.
- Viral upper respiratory infections frequently precipitate attacks.
- Increased air pollution is also a contributing factor.
Signs and Symptoms
- Cough, marked dyspnea, a tight feeling in the chest, and agitation develop as airway obstruction increases. The patient may be unable to talk.
- Wheezing is characteristic as air passes through the narrowed bronchioles.
- Breathing is rapid and labored, with the use of accessory muscles and possible chest retractions.
- Thick and tenacious or sticky mucus is coughed up.
- Marked fatigue causes decreased respiratory effort with a weaker cough.
- Respiratory failure is indicated by decreasing responsiveness, cyanosis, and arterial blood gas measurements indicating a $PaO<em>2$ of less than 50 mm Hg or a $PaCO</em>2$ of greater than 50 mm Hg.

A condition where the parenchyma of the lung becomes inflamed.
Classification of pneumonias based on:
- Cause: Viral, bacterial, fungal.
- Anatomical location: Throughout both lungs or consolidated in one lobe.
- Epidemiologic data: Nosocomial (hospital-acquired), community-acquired, or aspiration (major predisposing factor).
In some pneumonias, such as viral pneumonia, pathophysiologic changes occur primarily in the lung tissue.
In other types, such as pneumococcal pneumonia, the alveoli are inflamed and filled with fluid (exudate).
The filling of the alveoli with exudate reduces the diffusion of gases, particularly oxygen, and decreases blood flow through the affected lobe.
Hypoxia results and is more marked because the demand for oxygen increases with the higher metabolic rate associated with the infection.
Pulmonary empyema is a collection of pus in the pleural space most commonly caused by pulmonary infection.

Pharmacological
- Antibiotics, antifungals, antivirals
- Steroids
- Bronchodilators
Oxygen therapy
- Oxygen adjuncts
- Positive pressure ventilation (CPAP, BiPAP) to allow for gas exchange
Education
- Infection control (hand hygiene)
- Vaccinations (pneumococcal vaccine)

Hubert, Robert J. and VanMeter, Karin C. (2018) Gould's Pathophysiology for the Health Professions, Sixth Edition. Elsevier.
Ignatavicius, D. D., Workman, M. L., Rebar, Cherie R. and Heimgartner, Nicole M. (2018) Medical-Surgical Nursing: Concepts For Interprofessional Collaborative Care, Ninth Edition. Saunders-Elsevier. “